Percutaneous array delivery system

ABSTRACT

A system for treating tissue includes a cannula having a proximal end, a distal end, and a lumen extending between the proximal and the distal ends, and an array of delivery tubes at least partially disposed within the lumen, each of the delivery tube having a lumen, wherein each of the delivery tubes is slidable relative to the cannula, and has a first configuration when inside the lumen, and a second configuration when outside the lumen. A system for treating tissue includes a treatment device having a distal end, and an indexing device for controlling a longitudinal position of the distal end of the treatment device relative to a target tissue region, the indexing device having a tubular portion for receiving the treatment device.

FIELD OF THE INVENTION

The field of the invention relates generally to systems and methods forthe treatment of tissue, and more particularly, to systems and methodsfor performing microsphere radiotherapy.

BACKGROUND

Many types of medical procedures involve delivering treatment particleswithin a body. For example, physicians have injected radioactiveparticles into a human body for providing radioactive treatment attarget tissue regions.

Currently, delivery of radioactive particles involve injecting theradioactive particles into an artery, and allowing the particles to becarried by blood stream to target site (e.g., a tumor). At the targetsite, the distribution of the radioactive particles depends on thegeometry and configuration of the vessels at the tumor. Since vessels ata tumor site are usually irregular in pattern, the distribution of theradioactive particles at the tumor site is usually non-uniform. As aresult, parts of a tumor may receive more radiation dose than desired,while other parts of the tumor may receive an insufficient amount ofradiation dose, or in some case, may not receive any radiation dose.

Another problem associated with the current technique of deliveringradioactive particles is that after the particles are injected into theartery, the particles may migrate to an unintended site, e.g., a healthytissue region. As a result, the target site does not receive theintended dose of radiation, and healthy tissue at the healthy tissueregion are injured by the radiation emitted by the radioactiveparticles.

Thus, there remains a need to provide for improved systems and methodsfor delivering treatment particles.

SUMMARY

In accordance with some embodiments, a system for treating tissueincludes a cannula having a proximal end, a distal end, and a lumenextending between the proximal and the distal ends, and an array ofdelivery tubes at least partially disposed within the lumen, each of thedelivery tube having a lumen, wherein each of the delivery tubes isslidable relative to the cannula, and has a first configuration wheninside the lumen, and a second configuration when outside the lumen.

In accordance with other embodiments, a method for treating tissueincludes inserting a cannula into a body, deploying a plurality ofdelivery tubes from a lumen of the cannula such that the plurality ofdelivery tubes are at a first position within a target tissue region,and delivering a first treatment particle from each of the plurality ofdelivery tubes to the target tissue region.

In accordance with other embodiments, a system for treating tissueincludes a treatment device having a distal end, and an indexing devicefor controlling a longitudinal position of the distal end of thetreatment device relative to a target tissue region, the indexing devicehaving a tubular portion for receiving the treatment device.

Other and further aspects and features of the embodiments will beevident from reading the following detailed description of the preferredembodiments, which are intended to illustrate, not limit, the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the design and utility of preferred embodiments.It should be noted that the figures are not drawn to scale and thatelements of similar structures or functions are represented by likereference numerals throughout the figures. In order to better appreciatehow the above-recited and other advantages and objects of theembodiments are obtained, a more particular description of theembodiments will be rendered, which are illustrated in the accompanyingdrawings. Understanding that these drawings depict only typicalembodiments and are not therefore to be considered limiting of itsscope, the embodiments will be described and explained with additionalspecificity and detail through the use of the accompanying drawings inwhich:

FIG. 1 is a perspective view of a tissue treatment system in accordancewith some embodiments of the invention;

FIG. 2 is a side cross-sectional view of a treatment device used in thesystem of FIG. 1, wherein an array of delivery tubes is particularlyshown deployed;

FIG. 3 is a side cross-sectional view of a treatment device used in thesystem of FIG. 1, wherein an array of delivery tubes is particularlyshown retracted;

FIG. 4 is a perspective view of an indexing device used in the system ofFIG. 1;

FIG. 5 is a perspective view of an indexing device in accordance withother embodiments; and

FIGS. 6A-6F illustrate a method for treating tissue in accordance withsome embodiments.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Various embodiments of the present invention are described hereinafterwith reference to the figures. It should be noted that the figures arenot drawn to scale and elements of similar structures or functions arerepresented by like reference numerals throughout the figures. It shouldalso be noted that the figures are only intended to facilitate thedescription of specific embodiments. They are not intended as anexhaustive description of the invention or as a limitation on the scopeof the invention. In addition, an aspect described in conjunction with aparticular embodiment is not necessarily limited to that embodiment andcan be practiced in any other embodiments.

FIG. 1 illustrates a tissue treatment system 2 in accordance with someembodiments. The tissue treatment system 2 includes a treatment device 4configured for delivering treatment particles to a target tissue regionwithin a body, and an indexing device 6 for controlling a position ofthe treatment device 4 relative to the target tissue region.

Referring specifically now to FIGS. 2 and 3, the treatment device 4includes an elongate cannula 12, a shaft 20 slidably disposed within thecannula 12, and a plurality of delivery tubes 26 carried by the shaft20. The cannula 12 has a distal end 14, a proximal end 16, and a centrallumen 18 extending through the cannula 12 between the distal end 14 andthe proximal end 16. The cannula 12 may be rigid, semi-rigid, orflexible depending upon the designed means for introducing the cannula12 to the target tissue. The cannula 12 is composed of a suitablematerial, such as plastic, metal or the like, and has a suitable length,typically in the range from 5 cm to 30 cm, preferably from 10 cm to 20cm. The length of the cannula 12 can also have other dimensions. Thecannula 12 has an outside cross sectional dimension consistent with itsintended use, typically being from 0.5 mm to 5 mm, usually from 1.3 mmto 4 mm. The cannula 12 may have an inner cross sectional dimension inthe range from 0.3 mm to 4 mm, preferably from 1 mm to 3.5 mm. Thecannula 12 can also have other outside and inner cross sectionaldimensions in other embodiments.

It can be appreciated that longitudinal translation of the shaft 20relative to the cannula 12 in a distal direction 40 deploys the deliverytubes 26 from the distal end 14 of the cannula 12 (FIG. 2), andlongitudinal translation of the shaft 20 relative to the cannula 12 in aproximal direction 42 retracts the shaft 20 and the delivery tubes 26into the distal end 14 of the cannula 12 (FIG. 3). The shaft 20comprises a distal end 22 and a proximal end 24. Like the cannula 12,the shaft 20 is composed of a suitable material, such as plastic, metalor the like.

In the illustrated embodiment, each delivery tube 26 is in the form of asmall diameter element, which can penetrate into tissue as it isadvanced from a target site within the target region. In someembodiments, distal ends 66 of the delivery tubes 26 may be honed orsharpened to facilitate their ability to penetrate tissue. The distalends 66 of these delivery tubes 26 may be hardened using conventionalheat treatment or other metallurgical processes. In the illustratedembodiments, the delivery tubes 26 extend through the length of thecannula 12. Alternatively, the delivery tubes 26 can be shorter. Forexample, the delivery tubes 26 can extend through a portion of thecannula 12.

The delivery tubes 26 can have a variety of cross-sectional shapes. Inthe illustrated embodiments, the delivery tubes 26 have rectangularcross-sections. The rectangular cross-sections make the delivery tubes26 stiffer in one direction (e.g., the transverse direction) and moreflexible in another direction (e.g., the radial direction). Byincreasing transverse stiffness, proper circumferential alignment of thedelivery tubes 26 within the lumen 18 of the cannula 12 is enhanced.Exemplary delivery tubes will have a width (in the circumferentialdirection) in the range from 0.2 mm to 0.6 mm, preferably from 0.35 mmto 0.40 mm, and a thickness (in the radial direction) in the range from0.05 mm to 0.3 mm, preferably from 0.1 mm to 0.2 mm. In otherembodiments, the cross-sections of the delivery tubes 26 may benon-rectangular. For examples, the delivery tubes 26 can have acircular, elliptical, or a square profile, and the like.

When deployed from the cannula 12, the array 30 of delivery tubes 26 hasa deployed configuration that defines a volume having a periphery with aradius in the range from 0.1 to 4 cm. However, in other embodiments, themaximum radius can be other values, depending on a size and/or ageometry of a target tissue region. The delivery tubes 26 are resilientand pre-shaped to assume a desired configuration when advanced intotissue. In the illustrated embodiment, the delivery tubes 26 divergeradially outwardly from the cannula 12 in a uniform pattern, i.e., withthe spacing between adjacent delivery tubes 26 diverging in asubstantially uniform and/or symmetric pattern. As shown in the figure,the deployed delivery tubes 26 each has a profile that resembles atleast a portion of a parabola. However, in other embodiments, each ofthe deployed delivery tubes 26 can have other deployed profiles, such abent profile, a rectilinear profile, or a customized profile.

It should be noted that although a total of two delivery tubes 26 areillustrated in FIG. 2, in other embodiments, the treatment device 4 canhave more or fewer than two delivery tubes 26. In exemplary embodiments,pairs of adjacent delivery tubes 26 can be spaced from each other insimilar or identical, repeated patterns and can be symmetricallypositioned about an axis of the shaft 20. It will be appreciated that awide variety of particular patterns can be provided to uniformly coverthe region to be treated. In other embodiments, the delivery tubes 26may be spaced from each other in a non-uniform pattern. Such feature maybe desirable to treat tissue region having a non-symmetrical geometry.

The delivery tubes 26 can be made from a variety of elastic materials.Very desirable materials of construction, from a mechanical point ofview, are materials which maintain their shape despite being subjectedto high stress. Certain “super-elastic alloys” include nickel/titaniumalloys, copper/zinc alloys, or nickel/aluminum alloys. Alloys that maybe used are also described in U.S. Pat. Nos. 3,174,851, 3,351,463, and3,753,700, the disclosures of which are hereby expressly incorporated byreference. The delivery tubes 26 may also be made from any of a widevariety of stainless steels. The delivery tubes 26 may also include thePlatinum Group metals, especially platinum, rhodium, palladium, rhenium,as well as tungsten, gold, silver, tantalum, and alloys of these metals.These metals are largely biologically inert. They also have significantradiopacity to allow the delivery tubes 26 to be visualized in-situ, andtheir alloys may be tailored to accomplish an appropriate blend offlexibility and stiffness. They may be coated onto the delivery tubes 26or be mixed with another material used for construction of the deliverytubes 26.

Returning to FIGS. 2 and 3, the treatment device 4 further includes ahandle assembly 27, which includes a handle portion 28 mounted to theproximal end 24 of the shaft 20, and a handle body 29 mounted to theproximal end 16 of the cannula 12. The handle portion 28 is slidablyengaged with the handle body 29 (and the cannula 20). The handle portion28 and the handle body 29 can be composed of any suitable rigidmaterial, such as, e.g., metal, plastic, or the like.

Optionally, a marker (not shown) may be placed on the handle portion 28and/or on the proximal end 24 of the shaft 20 for indicating arotational orientation or a position of the handle portion 28 relativeto the shaft 20 (and the delivery tubes 26) during use. In someembodiments, the handle assembly 27 can have an indexing feature. Forexample, the proximal end 24 of the shaft 20 or the handle portion 28can have one or more keys that mate with respective slot(s) at theinterior surface of the cannula 12 or the handle body 29. Such indexingfeature allows circumferential alignment of the shaft 20 (and the array30) relative to the cannula 12. Angle indexing devices that may be usedinclude those described in U.S. patent application Ser. No. 10/317,796,entitled “Angle Indexer For Medical Devices”, the entire disclosure ofwhich is expressly incorporated by reference herein. In otherembodiments, the handle portion 28 may also include a locking mechanism(not shown) to temporarily lock against the shaft 20 to provide a morestable indexing. For example, the locking mechanism may include anaxially-sliding clutch assembly that is slidable along an axis of theshaft 20 to thereby secure the handle portion 28 against the shaft 20.Other securing devices known in the art may also be used.

As shown in FIGS. 2 and 3, the treatment device 4 further includes aplunger assembly 100 for pushing treatment particles out of the lumensof the delivery tubes 26. In the illustrated embodiments, the plungerassembly 100 has a proximal portion 102, and a plurality of distalportions 104 secured to the proximal portion 102. Each of the distalportions 104 is sized to fit within a respective lumen 130 of thedelivery tube 26 of the treatment device 4. Such configuration allows aplurality of treatment particles to be delivered simultaneously from thedelivery tubes 26 by translating the proximal portion 102 relative tothe shaft 20. In other embodiments, instead of having a common proximalend, the plunger assembly 100 can include a plurality of plungers, eachof which sized to fit within a respective lumen 130 of the delivery tube26. Such configuration allows a physician to select which of thedelivery tubes 26 to use for delivering treatment particle(s) to atarget site. The plunger 100 can be made from an elastic material, suchas those suitable for construction of the delivery tubes 26. As shown inFIGS. 2 and 3, the plunger assembly 100 further includes markers 140 forindicating how many rounds of treatment particles 120 have beendelivered (or how many rounds of treatment particles 120 remain in thetreatment device 4).

In some embodiments, the delivery tubes 26 can be preloaded with thetreatment particles 120. In such cases, the treatment device 4 willfurther include the treatment particles 120. In the illustratedembodiments, the treatment particles are radioactive. For examples, thetreatment particles 120 can be coated with a radioactive substance, orbe entirely made from a radioactive substance. Alternatively, thetreatment particles 120 can include a bioactive agent. Also, in otherembodiments, the treatment particles 120 can include an agent forharming or destroying tissue. In further embodiments, instead of solidparticles, the treatment device 4 can be preloaded with liquid or a gel.For examples, the liquid or the gel can include a radioactive substance,a bioactive agent, or an agent for harming tissue.

Having described the treatment device 4, the indexing device 6 of thetissue treatment system 2 will now be described.

FIG. 4 shows the indexing device 6 in accordance with some embodiments.The indexing device 6 includes a tubular portion 200 sized to receive atleast a portion of the treatment device 4, and a base portion 202secured to the tubular portion 200. The base portion 202 is in a form ofa disk, and is adapted to be placed on a patient's skin during use.However, in other embodiments, the base portion 202 can have othershapes and configurations. Also, in further embodiments, the indexingdevice 6 does not include the base portion 202. In such cases, thetubular portion 200 can be directly placed on a patient's skin duringuse. Although the tubular portion 200 is shown to have a circular crosssection, in other embodiments, the tubular portion 200 can have othercross-sectional shapes.

In the illustrated embodiments, the indexing device 6 includes six slots210 a-210 f in the wall of the tubular portion 200. The slots 210 a-210c have different lengths. However, each set of opposing slots 210 havethe same length. As such, slots 210 a and 210 d have equal lengths,slots 210 b and 210 e have equal lengths, and slots 210 c and 210 f haveequal lengths. Each set of opposing slots 210 is sized to accommodate orto mate with extensions 212, 214 secured to the treatment device 4.During use, the treatment device 4 is placed into the tubular portion200 such that the extensions 212, 214 mate with one set of opposingslots 210. The lengths of the slots 210 determine how far the treatmentdevice 4 can translate relative to the tubular portion 200, therebyensuring that the treatment device 4 will be positioned relative to atarget tissue region in a predictable and repeatable manner. If desired,during treatment, the treatment device 4 can be retracted proximallyrelative to the tubular portion 200, and reinserted into the tubularportion 200 such that the extensions 212, 214 mate with another set ofopposing slots 210, thereby placing the treatment device 4 at a seconddesired position relative to a target tissue region. As shown in FIG. 4,the base portion 202 includes markers 230 for indicating which set ofslots 210 is being used. In some embodiments, the markers 230 can alsoinclude dimensions for indicating a position of a portion of thetreatment device 4 relative to a reference point, such as the baseportion 202, or a patient's surface. Also, in other embodiments, insteadof placing the markers 230 on the base portion 202, the markers 230 canbe placed on the tubular portion 200.

In other embodiments, instead of having opposing slots of equal lengths,each of the slots 210 on the indexing device 6 can have differentlengths. In such cases, the treatment device 4 has one extension (e.g.,extension 212) sized to alternately mate with each of the slots 210. Inaddition, although six slots 210 a-210 f are shown, in otherembodiments, the indexing device 6 can have other numbers of slots. Forexample, the indexing device 6 can have only one slot configured to matewith an extension on the treatment device 4. Such configuration ensuresthat the treatment device 4 will be accurately positioned at one desiredlocation within a target tissue region.

FIG. 5 illustrates a variation of the indexing device 6 in accordancewith other embodiments. The indexing device 6 also includes a tubularportion 300 and a base portion 302. However, unlike the embodiments ofFIG. 4, the indexing device 6 does not have a plurality of slots in thewall of the tubular portion 300. Instead, the indexing device 6 has aplurality of extensions 310 secured to the tubular portion 300. In suchcases, the treatment device 4 has a recess 312 sized to mate with eachof the extensions 310, thereby controlling a position of the treatmentdevice 4 relative to the tubular portion 300. The treatment device 4also includes additional recesses 314 for accommodating the rest of theextensions 310 while the recess 312 is engaged with one of theextensions 310. During use, the treatment device 4 is placed into thetubular portion 300 such that the recess 312 mates with one of theextensions 310. The position of each of the extensions 310 at thetubular portion 300 determines how far the treatment device 4 cantranslate relative to the tubular portion 200, thereby ensuring that thetreatment device 4 will be predictably placed at a desired position. Ifdesired, during treatment, the treatment device 4 can be retractedproximally relative to the tubular portion 300, and reinserted into thetubular portion 300 such that the recess 312 mates with another of theextensions 310, thereby predictably placing the treatment device 4 at asecond desired position.

It should be noted that the configuration of the indexing device 6should not be limited by the examples discussed previously, and that theindexing device 6 can have other configurations in other embodiments.

Referring now to FIGS. 6A-6F, the operation of the tissue treatmentsystem 2 is described in treating a treatment region TR within tissue Tlocated beneath the skin or an organ surface S of a patient. First, theindexing device 6 is placed against a patient's surface S (FIG. 6A). Thecannula 12 is then inserted into the tubular portion 200 of the indexingdevice 6, and is advanced until the extensions 212, 214 of the treatmentdevice 4 engage with a first group of opposing slots (one of them beingslot 210 a) at the tubular portion 200. The cannula 12 may have asharpened tip, e.g., in the form of a needle, to facilitate introductionto the tissue T. It is also desirable that the cannula 12 besufficiently rigid, i.e., have a sufficient column strength, so that itcan be accurately advanced through tissue T without significant bendingor buckling. In the illustrated embodiments, the engaged slots 210 arethe deepest slots, which allows the distal end 14 of the cannula 12 tobe introduced within the treatment region TR, and be placed at thedistal end of the treatment region TR (FIG. 6B).

Next, the shaft 20 is advanced distally relative to the cannula 12 todeploy the delivery tubes 26 radially outward from the distal end 14 ofthe cannula 12 (FIG. 6C). Particularly, the shaft 20 is advancedsufficiently, so that the array 30 of delivery tubes 26 is fullydeployed to span at least a portion of the treatment region TR.Alternatively, the delivery tubes 26 may be partially deployed ordeployed incrementally in stages during a procedure (thereby allowingparticles be delivered at different radial positions relative to alongitudinal axis of the treatment device 4).

After the delivery tubes 26 are deployed, the plunger assembly 100 isadvanced distally relative to the shaft 20 to deploy a treatmentparticle 120 from each of the delivery tubes 26 (FIG. 6D). Asillustrated in the figure, the indexing device 6 allows the treatmentparticles 120 be delivered to a first portion of the treatment region TRin a predictable manner.

If it is desired to deliver additional treatment particles to otherportion(s) of the treatment region TR, the shaft 20 can be retractedproximally relative to the cannula 12 to retract the delivery tubes 26.The cannula 12 is then retracted proximally until the extensions 212,214 are disengaged from the first engaged slots of the indexing device6. The cannula 12 is then turned axially and advanced relative to theindexing device 6 until the extensions 212, 214 engage with a second setof opposing slots of the indexing device 6 (FIG. 6E). As shown in thefigure, because the second slot 210 b is shorter than the first slot 210a, the distal end 14 of the cannula 12 is proximal to the first group ofdelivered treatment particles 120. Next, the shaft 20 is advanceddistally relative to the cannula 12 to deploy the delivery tubes 26radially outward from the distal end 14 of the cannula 12, and theplunger assembly 100 is advanced distally to deploy a second group oftreatment particles 120 at a second portion of the target region TR(FIG. 6F).

If desired, the above steps of retracting the delivery tubes 26,retracting the cannula 12, reinserting the cannula 12, redeploying thedelivery tubes 26, and advancing the plunger assembly 100, can berepeated until a sufficient number of treatment particles 120 have beendelivered to cover the treatment region TR.

As can be appreciated by those skilled in the art, the indexing device 6and the uniformly spaced delivery tubes 26 allow the treatment particlesto be delivered to the treatment region TR in an uniform and/orpredictable manner. The treatment system 2 is easy to use, and requireslittle technique by the physician. Also, use of the treatment device 4to deliver treatment particles 120 directly to the target site (i.e.,without using a vessel to distribute the particles) reduces the riskthat the treatment particles 120 will migrate to an unintended site.

Although the above embodiments have been described with reference totreatment devices configured for delivering treatment particles, thescope of the present invention should not be so limited. In otherembodiments, the treatment device 4 can be other types of medicaldevices, or components of other types of medical devices. For examples,in other embodiments, the treatment device 4 can be a conventionalneedle or a surgical cutting device. In such cases, the indexing device6 can still be used to control the position of the treatment device 4relative to a target tissue region.

In further embodiments, the treatment device 4 can be an ablation devicehaving one or more electrodes. For example, the treatment device 4 canbe an ablation apparatus that includes a plurality of electrode tinesdeployable from a cannula, such as those described in U.S. Pat. No.5,855,576. Each of the tines includes a proximal end that is coupled toa generator, and a distal end that may project from a distal end of thecannula. The tines are arranged in an array with the distal ends locatedgenerally radially and uniformly spaced apart from the distal end of thecannula. The tines may be energized in a bipolar mode (i.e., currentflows between closely spaced electrode tines) or a monopolar mode (i.e.,current flows between one or more electrode tines and a larger, remotelylocated common electrode) to heat and necrose tissue within a preciselydefined volumetric region of target tissue. When using the abovedescribed devices in percutaneous interventions, the cannula is insertedinto the indexing device 6 and through a patient's skin. When the distalend of the cannula is desirably positioned, the tines are then deployedout of the distal end of the cannula to penetrate target tissue, and areenergized to ablate the target tissue. The indexing device 6 can then beused to control a position of the distal end of the cannula relative toa target site, thereby allowing multiple ablation zones be created atdesired positions. For example, a first ablation zone can be created ata first region of a target region, and the indexing device 6 can be usedto create a second ablation zone at a second region that is proximal tothe first region. The second ablation zone may or may not overlap aportion of the first ablation zone. As will be appreciated by thoseskilled in the art, the longitudinal indexing feature provided by theindexing device 6 allows a physician to create ablation zones in apredictable and repeatable manner.

Although particular embodiments have been shown and described, it shouldbe understood that the above discussion is not intended to limit thepresent invention to these embodiments. It will be obvious to thoseskilled in the art that various changes and modifications may be madewithout departing from the spirit and scope of the present invention.Thus, the present invention is intended to cover alternatives,modifications, and equivalents that may fall within the spirit and scopeof the present invention as defined by the claims.

1-30. (canceled)
 31. A tissue treatment system comprising: an elongatedcannula having a proximal end a distal end and a lumen extending therebetween; a handle body mounted to a proximal portion of the elongatedcannula, the handle body comprising at least one extension projectingfrom the handle body; a shaft slidably disposed with the lumen of thecannula, the shaft including a plurality of delivery tubes carried by adistal portion of the shaft, the delivery tubes including respectivelumens configured for carrying a treatment material; a plunger assemblyslidably disposed relative to the shaft and configured to push thetreatment material out of the respective lumens of the delivery tubes;and an indexing device comprising a tubular portion having a pluralityof slots configured to receive the at least one extension, at least someof the plurality of slots having different lengths.
 32. The system ofclaim 31, wherein the handle body comprises a plurality of extensionsprojecting from the handle body.
 33. The system of claim 32, wherein theplurality of extensions are located on opposing sides of the handle bodyand wherein the plurality of slots comprises a plurality of pairs ofopposing slots disposed in the tubular portion, each respective opposingpair having substantially the same slot length.
 34. The system of claim31, wherein the handle body comprises a single extension and theplurality of slots comprise slots of different lengths.
 35. The systemof claim 31, wherein the treatment material comprises treatmentparticles.
 36. The system of claim 31, wherein the treatment materialcomprises a liquid.
 37. The system of claim 31, wherein the treatmentmaterial comprises a gel.
 38. The system of claim 35, wherein thetreatment particles are radioactive.
 39. The system of claim 35, whereinthe treatment particles comprise a bioactive agent.
 40. The system ofclaim 39, wherein the bioactive agent harms or destroys tissue.
 41. Thesystem of claim 31, wherein the delivery tubes have a cross-sectionalshape selected from the group consisting of rectangular, circular,elliptical, and square.
 42. The system of claim 31, further comprising ahandle affixed to a proximal portion of the shaft.
 43. The system ofclaim 31, wherein the indexing device comprising a base portion affixedto the tubular portion.
 44. The system of claim 31, wherein the plungerassembly comprises a proximal portion and a plurality of distalportions, the plurality of distal portions configured to push thetreatment material out of the respective lumens of the delivery tubes.45. A tissue treatment system comprising: an elongated cannula having aproximal end a distal end and a lumen extending therebetween; a handlebody mounted to a proximal portion of the elongated cannula, the handlebody comprising a plurality of slots, at least some of the plurality ofslots having different lengths; a shaft slidably disposed with the lumenof the cannula, the shaft including a plurality of delivery tubescarried by a distal portion of the shaft, the delivery tubes includingrespective lumens configured for carrying a treatment material; aplunger assembly slidably disposed relative to the shaft and configuredto push the treatment material out of the respective lumens of thedelivery tubes; and an indexing device comprising a tubular portionhaving at least one extension projecting from the tubular portion andconfigured to engage with the plurality of slots in the handle body. 46.The system of claim 45, wherein the tubular portion has a plurality ofextensions projecting there from.
 47. The system of claim 46, whereinthe plurality of extensions are located on opposing sides of the tubularportion and wherein the plurality of slots comprises a plurality ofpairs of opposing slots disposed in the handle body, each respectiveopposing pair having substantially the same slot length.
 48. The systemof claim 45, wherein the tubular body comprises a single extension andthe plurality of slots comprise slots of different lengths.
 49. Thesystem of claim 45, wherein the treatment material comprises treatmentparticles.
 50. The system of claim 45, wherein the treatment materialcomprises a liquid.
 51. The system of claim 45, wherein the treatmentmaterial comprises a gel.
 52. The system of claim 49, wherein thetreatment particles are radioactive.
 53. The system of claim 49, whereinthe treatment particles comprise a bioactive agent.
 54. The system ofclaim 53, wherein the bioactive agent harms or destroys tissue.
 55. Thesystem of claim 45, wherein the delivery tubes have a cross-sectionalshape selected from the group consisting of rectangular, circular,elliptical, and square.
 56. The system of claim 45, further comprising ahandle affixed to a proximal portion of the shaft.
 57. The system ofclaim 45, wherein the indexing device comprising a base portion affixedto the tubular portion.
 58. The system of claim 45, wherein the plungerassembly comprises a proximal portion and a plurality of distalportions, the plurality of distal portions configured to push thetreatment material out of the respective lumens of the delivery tubes.59. A method for treating tissue, comprising: placing an indexing deviceagainst a surface of a body, the indexing device comprising a tubularmember having a plurality of slots therein; inserting a treatment deviceinto the indexing device, the treatment device including one or moreextensions configured to fit within the plurality of slots; deploying aplurality of delivery tubes from the treatment device such that theplurality of delivery tubes are at a first position within a targettissue region; and delivering a treatment material from the plurality ofdelivery tubes to the target tissue region.
 60. The method of claim 59,wherein the treatment material comprises treatment particles.
 61. Themethod of claim 59, wherein the treatment material comprises a liquid.62. The method of claim 59, wherein the treatment material comprises agel.
 63. The method of claim 60, wherein the treatment particles areradioactive.
 64. The method of claim 60, wherein the treatment particlescomprise a bioactive agent.
 65. A method for treating tissue,comprising: placing an indexing device against a surface of a body, theindexing device comprising a tubular member having one or moreextensions; inserting a treatment device into the indexing device, thetreatment device including a plurality of slots configured to receivethe one or more extensions; deploying a plurality of delivery tubes fromthe treatment device such that the plurality of delivery tubes are at afirst position within a target tissue region; and delivering a treatmentmaterial from the plurality of delivery tubes to the target tissueregion.
 66. The method of claim 65, wherein the treatment materialcomprises treatment particles.
 67. The method of claim 65, wherein thetreatment material comprises a liquid.
 68. The method of claim 65,wherein the treatment material comprises a gel.
 69. The method of claim66, wherein the treatment particles are radioactive.
 70. The method ofclaim 66, wherein the treatment particles comprise a bioactive agent.